Table 1 ACC/AHA guidelines for endovascular therapy in peripheral arterial disease4

Indication	Recommendation	Level of evidence
Claudication:
Class I	EVT is indicated for vocational or lifestyle-limiting disability due to IC if there is reasonable likelihood of symptomatic improvement with EVT and (a) response to exercise or pharmacological therapy is inadequate and/or (b) favourable risk/benefit ratio (eg, focal aortoiliac occlusive disease)	A
	EVT is preferred revascularisation technique for simple iliac and femoropopliteal arterial lesions	B
	Provisional stent placement in iliac arteries for suboptimal or failed result from balloon dilation	B
	Stenting is effective as primary therapy for common iliac and external iliac artery stenoses and occlusions	B and C
Class IIa	Stents (and other adjunctive techniques such as lasers, cutting balloons, atherectomy devices and thermal devices) can be useful in the femoral, popliteal and tibial arteries for a suboptimal or failed result from balloon dilation	C
Class III	Primary stent placement is not recommended in the femoral, popliteal, or tibial arteries	C
Class III	EVT is not indicated as prophylactic therapy in a patient who is asymptomatic with lower extremity PAD	C
Critical limb ischaemia:
Class I	Inflow lesions should be revascularised first	C
Class I	Outflow revascularisation should be performed when symptoms of CLI or infection persist after inflow revascularisation.	B
Class III	EVT is not indicated in patients with severe decrements in limb perfusion (eg, ABI<0.4) in the absence of clinical symptoms of CLI	C

ABI, ankle–brachial index; ACC, American College of Cardiology; AHA, American Heart Association; CLI, critical limb ischaemia; EVT, endovascular therapy; IC, intermittent claudication; PAD, peripheral arterial disease.